Finding The Right Medical Team For Your Needs—Without Going Broke

You know the drill. Find a doctor you think you’ll love, call her office, then find out she’s not in your insurance network. Or make a date with a dentist (which was hard enough to do), get your teeth fixed, and then get handed a bill that looks a lot like your car payment. It never ends.

Even when you’re (more or less) perfectly healthy and you’ve got good health insurance, medical costs are dicey. They can add up fast. And in crisis—a sudden stomach virus, for instance—it can seem like getting to the nearest doctor is the only thing that matters.

Knowing who to go to for different health problems can save you a lot of physical, emotional, and financial pain in the long run. Here’s how to find the right medical team for your needs.

If you pick emergency care for the wrong thing, that’s money—pretty much a guaranteed bill. Find out what your health insurance considers an “emergency.” Chest pain and major bleeding probably count. A headache? Maybe not.

How do you find out? Go to your insurance company’s website. Or call the member services number on your insurance card.

You’ll get a pretty good idea of where to go, and for what.

If you don’t have health insurance, you can still get treated in an emergency. Emergency rooms cannot turn you away. But you may have quite a big hospital bill later. Talk to the hospital’s billing department about a payment plan and maybe some debt forgiveness.

What if it’s not an emergency, and you don’t have health insurance? If you’re not insured at the moment and a health need comes up, you can get low-cost health care at a community health center.

You can find one on healthcare.gov or you might ask a local hospital or doctor’s office to point you to one. Also, local nonprofits can often tell you where to find community health centers or other low-cost medical care: churches, United Way, the YWCA, the Salvation Army, etc.

Remember, if you fall under certain income guidelines, you can get financial aid for health insurance because of the Affordable Care Act. Or you might qualify for Medicaid or Medicare. Check out healthcare.gov for more information.

Going To The Emergency Room (ER)

While a trip to the ER might cost 2 to 3 times as much as a trip to your primary care provider, there are situations where medical care just can’t wait.

For instance, head to the nearest ER if you or a loved one:

Are having a hard time breathing

Pass out

Get a really bad headache, especially if it starts suddenly

Feel weak on one side of your body

Are bleeding uncontrollably

Begin to cough or throw up blood

Are having an allergic reaction: difficulty breathing, swelling, or hives

Have a high fever and stiffness in your neck

Are throwing up uncontrollably

Feel suicidal

Have a seizure

Getting to the ER in an ambulance is another potentially serious expense, but sometimes it’s best to call 911 and let the pros get you to the hospital, especially when you or a loved one:

Are choking

Stop breathing

Injure your head, neck, or spine

Have severe chest pain

Heading To Urgent Care

Cost-wise, urgent care is a middle ground between the ER and your primary care provider. Urgent care centers are usually good at dealing with:

Colds

Flu

Earaches

Sore throats

Migraines

Mild fevers

Rashes

Sprains

Cuts and burns that aren’t too serious

But before you head to the nearest urgent care center, make sure you check that they are covered by your insurance. If you need recommendations, your insurance provider should be able to help. Your primary care provider might be able to recommend one, too.

And while urgent care centers can have extended night, weekend, and holiday availability, it’s always good to verify that as well before heading over.

Calling Your Primary Care Provider

As long as it’s not a medical emergency—in which case, head straight to the ER—it’s usually worth giving your primary care provider a call. Find out what he recommends you do for minor health issues, like a sore throat or the flu.

Some insurance providers also have nurse hotlines you can call for advice. Those can actually be really useful, especially if you need help outside of normal office hours.

When It’s Time To See A Specialist

Your primary care physician is usually a good starting point for getting help with medical issues. But there are times when it’s best to see a specialist—a doctor who’s had extra training in a specific area, like heart disease or diabetes.

Your primary care provider might recommend a specialist for you. In some cases, your insurance plan might even require that you get a referral from your primary care provider before seeing a specialist. Call your insurance company and find out their rules about this. Otherwise, specialist bills are not pretty.

When Someone Other Than A Doctor Can Help You

Not every medical issue needs to be diagnosed or treated by a doctor with the letters “MD” after her name. In fact, depending on where you go for care, you might see:

Knowledge is power. In this case, it can be a money saver, too. If you have a friend or family member who is concerned about medical costs, share this link with them. Their health—and their wallets—will thank you.